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RtUW <br />VEE SAN JOAQUIN COUNTY EHD LOG NUMBER <br />MAY1 ��6'ENVIRONMENTAL HEALTH DEPARTME, 96 N <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Tele hone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRONMENTALPERMIIncr-e TH PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:-�J aJ Imo(. �s�fa • e� BUSINESS/AGENCY: <br />ADDRESS: E£� /a�`E:,l<d aC CITY/STATE/ZIP: <br />PHONE (1): PHONE (2):,_2-1� FAX OR E-MAIL:'.'jMc ",A Wg mr�,r"\ <br />Please allow 10 bsiness days from date of application submittal for the records to be available. <br />Staff will contact ou to arrange an appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPAthspace� <br />EQUES — $1 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT/ ✓ �.._ DATE .' �� <br />1. List up to ten addresses <br />below. Select the type(s) of files from the list below by checking the appropriate <br />box(es). At least one file typUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. Address <br />ranges will not be accepted.plications received after 3:00 pm will be processed the next business day. <br />2. For assistance in identifying e nature and content of EHD records, please contact EHD at the number noted above. <br />3. The EHD will notify the applit if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of applicat. The files will be held for a maximum of five business days for review. Appointments <br />should be scheduled accordily. <br />4. Any file not returned in the sa condition as released will be reorganized by EHD staff at the expense of the applicant. <br />Future file reviews by the Saapplicant may require a $139 deposit prior to review.WELL AND SEPTIC PERMIT RECRDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES <br />FILE ADDRESS <br />EHD USE ONLY <br />UNDERGROUND TANK (UST) <br />S reet # <br />Street Name <br />City <br />I ' ' CONSUMER <br />CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -L <br />1 <br />L) <br />. drj i ,�: k t, T;^ 5 4 ,y'' <br />( �S'� L]4 iV4. <br />/1. <br />�•°' <br />'. <br />1 <br />2 <br />Ud <br />HAZARDOUS WASTE <br />TIERED PERMITTED FACILITY <br />ABOVEGROUND TANK <br />E]UAIRY <br />3 <br />y ` <br />L <br />,\/� '� ❑ PWS <br />("d' <br />jl�4 <br />ryy..G...,,,LUST (MONITORING/ REMOVAL)p <br />HAZARDOUS MATERIALS <br />SPILIRELEASE RESPONSE <br />SOLID WASTE FACILITY /VEHICLE <br />4(�(� <br />WATER QUALITY <br />FOOD FACILITY <br />ITE MITIGATION <br />POOL/ SPA <br />DAIRY <br />5 <br />LAND USE APPLICATION SITES <br />SEPTIC PUMPER TRUCK / <br />B <br />E] HOUSING <br />YARD / CHEMICAL TOILETS <br />WASTEWATER TREATMENT PLANT <br />5jCUPA <br />F] HOUSING ABATEMENT <br />7 <br />MOTEL/HOTEL <br />8 <br />CUPA - UST <br />CHICKEN RANCH I DOG KENNEL <br />MEDICAL WASTE FACILITY <br />TATTOO/BODY PIERCING <br />SOLID WASTE <br />WASTE TIRE <br />COMPLAINT <br />g <br />❑ ACCOUNTING <br />F] OTHER(PLEASE SPECIFY): <br />10 <br />